1795. Safety Outcomes of the Use of β-Lactam Therapy in Patients With Documented β-Lactam Allergy

Abstract

BackgroundIn patients with a true penicillin allergy, the reported cross-reactivity to cephalosporin and carbapenem antibiotics are approximately 3% and 1%, respectively. Although true β-lactam allergies are rare, providers are reluctant to challenge patients with other β-lactams, which significantly limits empiric treatment reigmens. This study aims to determine the safety outcomes of patients with a previously documented β-lactam allergy who were challenged with β-lactam therapy at a small community hospital in Brooklyn, New York.MethodsA retrospective chart review of all β-lactam allergic patients at Kingsbrook Jewish Medical Center who received a β-lactam from January 2014 to July 2017. Patients were included if they were at least 18 years old with a documented β-lactam allergy upon admission and received at least one dose of a β-lactam antibiotic. Allergic reaction was determined by assessing both pharmacist and provider notes in the electronic health record. Orders for antihistamines, corticosteroids, and/or epinephrine in addition to the discontinuation of the β-lactam and provider documentation were considered an allergic reaction.ResultsA total of 108 patients were analyzed with 36 not meeting inclusion criteria. Of the 72 patients included, two patients (2.78%) experienced an allergic reaction to a β-lactam. Both patients recovered within 72 hours without the use of epinephrine. One of the allergic reactions was attributed to ceftriaxone, while the other was attributed to cefepime. The most commonly prescribed antibiotics were cefepime (34.7%), ceftriaxone (27.8%), and meropenem (15.3%). Eleven patients had a documented severe β-lactam allergy, one of which experienced a rash after receiving β-lactam therapy. None of the five patients with documented anaphylactic allergy experienced a reaction.ConclusionThis study demonstrated that there is a low risk of utilizing β-lactams in patients with a reported β-lactam allergy. The two observed allergic reactions were due to a third- and fourth-generation cephalosporin, which was unexpected as previous literature suggests higher cross-reactivity to the earlier generation cephalosporin antibiotics.Disclosures All authors: No reported disclosures.